AIM: To investigate the etiology, diagnosis and treatment of spontaneous perforation of the colon. METHODS: The clinical data of 10 cases of spontaneous perforation of the colon, observed at Fuding hospital from Janua...AIM: To investigate the etiology, diagnosis and treatment of spontaneous perforation of the colon. METHODS: The clinical data of 10 cases of spontaneous perforation of the colon, observed at Fuding hospital from January 2004 to December 2007, were analyzed retrospectively. RESULTS: The mean age at onset was 65 years (range from 45 to 73). Seven patients had a history of chronic constipation. All patients complained of sudden lower abdominal pain. The perforation occurred after coloclysis and administration of senna leaves in two patients. Nine patients had signs of peritoneal irritation. Seven cases underwent abdominal paracentesis, which was diagnostic in six. Only one case was definitely diagnosed prior to surgery. One patient underwent neoplasty of the colon, another a partial resection of colon, six a neoplasty of the colon plus sigmoid colostomy, and two underwent Hartmann surgery. All perforation sites were opposite to the mesenteric edge. The perforation sites were located on descending colon in one case, sigmoid colon in three cases, and rectosigmoid colon in six cases. In five patients, surgical pathological examination was consistent with the microscopical changes of colonic perforation caused by feces. Three patients died after surgery. CONCLUSION: Spontaneous perforation of the colon most commonly occurs among the elderly with chronic constipation. Abdominal paracentesis is helpful for the diagnosis. The perforation site is located opposite to the mesenteric edge. Sigmoid colon and rectosigmoid colon are the most frequent locations. Neoplasty of the colon and sigmoid colostomy are the most frequenttreatment. The prognosis is bad and the mortality rate after surgery is high.展开更多
Objective: To present a case of spontaneous perforation of colon. Introduction: Spontaneous perforation of colon (SPC) is defined as sudden perforation of apparently healthy colon in absence of diseases or injury. SPC...Objective: To present a case of spontaneous perforation of colon. Introduction: Spontaneous perforation of colon (SPC) is defined as sudden perforation of apparently healthy colon in absence of diseases or injury. SPC is an uncommon clinical entity which is seldom reported in literature, less than 100 cases were reported. Case report: A 82-year-old gentleman presented to emergency room (ER) with acute abdominal pain, for few hours duration. Pain started paraumbilically with sudden onset and then with increasing intensity became generalized. It was associated with nausea and vomiting. On general examination, he was conscious, alert. His vital signs: afebrile, pulse: 106/m, B.P: 140/100, local examination showed generalized abdominal tenderness & guarding with absent intestinal sounds. P.R. exam showed remnants of stool with blood stain on gloves, no masses. Computerized tomography (CT) abdomen showed perforation of cecum. He was taken to operation room (OR) and right hemicolectomy was done. Post operative period was uneventful and he was discharged in good health. Conclusion: SPC is a serious condition with high morbidity and mortality due to delay in diagnosis and management so, every effort should be made to make diagnosis especially in elderly and prompt surgical intervention should be done.展开更多
BACKGROUND Although the treatment guidelines for left sided diverticulitis are clear,the management of right colonic diverticulitis is not well established.This disease can no longer be ignored due to significant spre...BACKGROUND Although the treatment guidelines for left sided diverticulitis are clear,the management of right colonic diverticulitis is not well established.This disease can no longer be ignored due to significant spread throughout Asia.AIM To analyse epidemiology,diagnosis and treatment of right-sided diverticulitis in western countries.METHODS MEDLINE and PubMed searches were performed using the key words "rightsided diverticulitis","right colon diverticulitis","caecal diverticulitis","ascending colon diverticulitis" and "caecum diverticula" in order to find relevant articles published until 2021.RESULTS A total of 18 studies with 422 patients were found.Correct diagnosis was made only in 32.2%,mostly intraoperatively or via CT scan.The main reason for misdiagnosis was a suspected acute appendicitis(56.8%).The treatment was a nonoperative management(NOM)in 184 patients(43.6%)and surgical in 238 patients(56.4%),seven of which after NOM failure.Recurrence rate was low(5.45%),similar to eastern studies and inferior to left-sided diverticulitis.Recurrent patients were successfully conservatively retreated in most cases.CONCLUSION The management of right-sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left-sided diverticulitis.Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality.NOM offers a safe and effective treatment;surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded.Further studies are needed to clarify the correct treatment.展开更多
文摘AIM: To investigate the etiology, diagnosis and treatment of spontaneous perforation of the colon. METHODS: The clinical data of 10 cases of spontaneous perforation of the colon, observed at Fuding hospital from January 2004 to December 2007, were analyzed retrospectively. RESULTS: The mean age at onset was 65 years (range from 45 to 73). Seven patients had a history of chronic constipation. All patients complained of sudden lower abdominal pain. The perforation occurred after coloclysis and administration of senna leaves in two patients. Nine patients had signs of peritoneal irritation. Seven cases underwent abdominal paracentesis, which was diagnostic in six. Only one case was definitely diagnosed prior to surgery. One patient underwent neoplasty of the colon, another a partial resection of colon, six a neoplasty of the colon plus sigmoid colostomy, and two underwent Hartmann surgery. All perforation sites were opposite to the mesenteric edge. The perforation sites were located on descending colon in one case, sigmoid colon in three cases, and rectosigmoid colon in six cases. In five patients, surgical pathological examination was consistent with the microscopical changes of colonic perforation caused by feces. Three patients died after surgery. CONCLUSION: Spontaneous perforation of the colon most commonly occurs among the elderly with chronic constipation. Abdominal paracentesis is helpful for the diagnosis. The perforation site is located opposite to the mesenteric edge. Sigmoid colon and rectosigmoid colon are the most frequent locations. Neoplasty of the colon and sigmoid colostomy are the most frequenttreatment. The prognosis is bad and the mortality rate after surgery is high.
文摘Objective: To present a case of spontaneous perforation of colon. Introduction: Spontaneous perforation of colon (SPC) is defined as sudden perforation of apparently healthy colon in absence of diseases or injury. SPC is an uncommon clinical entity which is seldom reported in literature, less than 100 cases were reported. Case report: A 82-year-old gentleman presented to emergency room (ER) with acute abdominal pain, for few hours duration. Pain started paraumbilically with sudden onset and then with increasing intensity became generalized. It was associated with nausea and vomiting. On general examination, he was conscious, alert. His vital signs: afebrile, pulse: 106/m, B.P: 140/100, local examination showed generalized abdominal tenderness & guarding with absent intestinal sounds. P.R. exam showed remnants of stool with blood stain on gloves, no masses. Computerized tomography (CT) abdomen showed perforation of cecum. He was taken to operation room (OR) and right hemicolectomy was done. Post operative period was uneventful and he was discharged in good health. Conclusion: SPC is a serious condition with high morbidity and mortality due to delay in diagnosis and management so, every effort should be made to make diagnosis especially in elderly and prompt surgical intervention should be done.
文摘BACKGROUND Although the treatment guidelines for left sided diverticulitis are clear,the management of right colonic diverticulitis is not well established.This disease can no longer be ignored due to significant spread throughout Asia.AIM To analyse epidemiology,diagnosis and treatment of right-sided diverticulitis in western countries.METHODS MEDLINE and PubMed searches were performed using the key words "rightsided diverticulitis","right colon diverticulitis","caecal diverticulitis","ascending colon diverticulitis" and "caecum diverticula" in order to find relevant articles published until 2021.RESULTS A total of 18 studies with 422 patients were found.Correct diagnosis was made only in 32.2%,mostly intraoperatively or via CT scan.The main reason for misdiagnosis was a suspected acute appendicitis(56.8%).The treatment was a nonoperative management(NOM)in 184 patients(43.6%)and surgical in 238 patients(56.4%),seven of which after NOM failure.Recurrence rate was low(5.45%),similar to eastern studies and inferior to left-sided diverticulitis.Recurrent patients were successfully conservatively retreated in most cases.CONCLUSION The management of right-sided diverticulitis is not well clarified in the western world and no selective guidelines have been considered even if principles are similar to those with left-sided diverticulitis.Wrong diagnosis is one of the most important problems and CT scan seems to be the best imaging modality.NOM offers a safe and effective treatment;surgery should be considered only in cases of complicated diverticulitis or if malignancy cannot be excluded.Further studies are needed to clarify the correct treatment.
